Treatment Strategies for Transplant-Ineligible Patients With Multiple Myeloma

Shaji Kumar, MD, consultant of hematology, Mayo Clinic, discusses the shift in the treatment landscape for patients with multiple myeloma (MM), and how more patients are eligible for stem cell transplantation because of new criteria.

In the setting of newly diagnosed MM, there are many ongoing phase III clinical trials. Several of these studies include patients who are ineligible for stem cell transplantation. In the past melphalan, the backbone therapy for such patients, was used in this setting. A wider understanding of transplant eligibility has changed this. Aside from how old patients are, oncologists now look at factors like frailty and patient choice when deciding whether or not to use a melphalan-based approach.

In the modern landscape, the choice of therapy for newly diagnosed patients with MM is starting to be identical whether these patients are transplant eligible or ineligible. The treatment regimens used in this patient population are typically 3-drug or 4-drug combinations. Studies have found that even older patients can tolerate these same combinations, but they require lower dosages.